We base our NICU discharge decisions on physiologic criteria (rather than on weight or postconceptual age). Since establishment of oral feedings had previously delayed discharge in otherwise stable infants, we developed a teaching and evaluation program to examine prospectively the safety and efficacy of intermittent, in-home gavage feedings by NICU parents.

Methods Over a 12 month period, 36 families of NICU patients were given training in gavage feeding techniques. At the time of discharge, parents and visiting nurses were asked to start recording times, dates, methods, and amounts of feedings as well as weight gain and problems encountered. Complication data was available on all infants and gavage records for 85%.

Results There were over 968 successful in-home gavage feedings in 22 infants. Ten infants were not gavage fed at home. The median number of gavages per infant was 13 (range 1-145) and the median number of gavage-days per infant was 7 (range 1-42). The mean birth weight of infants in this group was 1,873 grams (range 770-3,800) and the mean postconceptual age at birth was 32 weeks (range 25-42 weeks). The mean discharge weight was 2,218 grams (range 1,225 to 4,180). The total number of days the patients were gavage fed was 340.

All infants gained weight. A median weight gain of 31 grams per day was seen in 15 of 26 infants with information available. There was no evidence of pulmonary aspiration, gavage tube malplacements, or hospital readmissions related to feedings. Four patients were readmitted for pyloric stenosis, increased oxygen need with BPD, H. influenzae type B pneumonia, and apnea.

Conclusion When parents are adequately prepared to gavage feed their NICU infants at home and when support services are available, in-home, intermittent gavage feeding by NICU parents is safe, effective, and saves hospital days.